Defense Health Agency

11/07/2024 | Press release | Distributed by Public on 11/07/2024 10:04

Check Out Your 2025 TRICARE Health Plan Costs

FALLS CHURCH, Va. - With 2025 just around the corner, you may be starting to consider your family's health needs for next year. There may be changes to your TRICARE health plan costs starting Jan. 1, 2025. Depending on your plan, these costs may include enrollment fees, premiums, cost-shares, and copayments.

Note: TRICARE costs may change each year based on the law, the federal cost of living adjustment, and the costs of healthcare services and prescription drugs.

"It's important to get familiar with TRICARE costs for 2025, as it can help you make the best healthcare coverage decision for your family during TRICARE Open Season," said Debra Fisher, health systems specialist, TRICARE Health Plan Policy and Programs, at the Defense Health Agency.

TRICARE Open Season is the annual period when anyone enrolled in or eligible for TRICARE Prime, US Family Health Plan, or TRICARE Select can make changes to their healthcare coverage. This year, open season begins Nov. 11 and ends Dec. 10. Changes you make during open season will take effect Jan. 1, 2025. Check out the TRICARE Newsroom article "TRICARE Enrollment Freeze and Scheduled milConnect and Beneficiary Web Enrollment Outage Beginning Oct. 25: What To Know" to understand some important dates as you review your plan this year.

Your beneficiary category and your beneficiary group determine the enrollment fees or premiums and out-of-pocket costs for your TRICARE plan. TRICARE beneficiaries fall into one of two groups:

  • Group A: Your or your sponsor's initial enlistment or appointment began before Jan. 1, 2018.
  • Group B: Your or your sponsor's initial enlistment or appointment began on or after Jan. 1, 2018.

If you're enrolled in a premium-based health plan, follow TRICARE Select Group B deductibles and applicable copayments and cost-shares listed in the tables below. The premium-based health plans are:

IMPORTANT: If you'll be living in the West Region on Jan. 1, 2025, you may need to provide your payment information to TriWest Healthcare Alliance, the incoming West Region contractor, by Dec. 31. You'll need to do this if you pay for your TRICARE coverage via bank electronic funds transfer or credit or debit card, but not if you pay by military pay system allotment. Check out the TRICARE Newsroom article "Live in the West Region? Update Your TRICARE Payment Information With TriWest" for more information.

Below are the lists of the calendar year 2025 costs for TRICARE health plans. Changes from 2024 costs are in bold.

Active duty family member costs

Active duty service members don't have out-of-pocket costs; however, active duty family members may. These costs depend on your TRICARE health plan, your sponsor's pay grade and group, what kind of care you get, and where you get care.

If you're enrolled in a TRICARE Prime plan, you won't have copayments unless you use the point-of-service option or fill a prescription outside of a military pharmacy.

Table 1 below shows your annual enrollment fee and annual deductible. Table 2 shows your annual catastrophic cap and network and non-network copayments and cost-shares. Changes from 2024 costs are in bold.

Table 1: CY 2025 TRICARE Prime and TRICARE Select enrollment fees and deductibles: active duty family members

TRICARE Prime TRICARE Select
Group A Group B Group A Group B
Annual enrollment fee Individual $0 $0 $0 $0
Family $0 $0 $0 $0
Annual deductible Individual
(E-4 and below) 		$0 $0 $50 $64
Family
(E-4 and below) 		$0 $0 $100 $128
Individual
(E-5 and above) 		$0 $0 $150 $193
Family
(E-5 and above) 		$0 $0 $300 $386

Table 2: CY 2025 TRICARE Prime and TRICARE Select out-of-pocket costs: active duty family members

TRICARE Prime** TRICARE Select
Group A Group B Group A Group B
Annual catastrophic cap $1,000 $1,288 $1,000 $1,288
Preventive care visit $0 $0 $0 $0
Primary care $0 $0 Network:
$27
Out-of-Network:
20%* 		Network:
$19
Out-of-Network:
20%*
Specialty care $0 $0 Network:
$38
Out-of-Network:
20%* 		Network:
$32
Out-of-Network:
20%*
Emergency room visit $0 $0 Network:
$105
Out-of-Network:
20%* 		Network:
$51
Out-of-Network:
20%*
Urgent care center visit $0 $0 Network:
$27
Out-of-Network:
20%* 		Network:
$25
Out-of-Network:
20%*
Ambulatory surgery $0 $0 Network and
Out-of-Network:
$25
 Network:
$32
Out-of-Network:
20%*
Ambulance, outpatient ground $0 $0 Network:
$86
Out-of-Network:
20%* 		Network:
$19
Out-of-Network:
20%*
Ambulance, outpatient air $0 $0 Network and
Out-of-Network:
20%* 		Network and
Out-of-Network:
20%*
Durable medical equipment $0 $0 Network:
15%
Out-of-Network:
20%* 		Network:
10%
Out-of-Network:
20%*
Inpatient admission $0 $0 Network and
Out-of-Network: $23.45
per day;
$25 minimum per admission 		Network:
$77 per admission
Out-of-Network:
20%*
Inpatient skilled nursing facility/rehab facility $0 $0 Network and
Out-of-Network: $23.45
per day;
$25 minimum per admission 		Network:
$32 per day
Out-of-Network:
$64 per day

*Percentage of TRICARE maximum-allowable charge after annual deductible is met.
**Getting care out of network may result in point-of-service charges.

Note: The costs for maternity care (delivery and inpatient) are the same costs for inpatient admission. The costs for inpatient mental health care are the same costs for inpatient admission. Mental health care (primary care) follows the same costs as for primary care. Mental health care (specialty care) follows the same costs as for specialty care.

Retired service members, their family members, and others

Table 3 below shows your TRICARE Prime and TRICARE Select annual enrollment fees and annual deductibles. Table 4 shows your TRICARE Prime and TRICARE Select catastrophic caps, network and non-network copayments, and cost-shares. Changes from 2024 costs are in bold.

Table 3: CY 2025 TRICARE Prime and TRICARE Select enrollment fees and deductibles: retirees, their family members, and all others

TRICARE Prime TRICARE Select
Group A Group B Group A Group B
Annual enrollment fee Individual $372 $450 $181.92 $579
Family $744 $900.96 $364.92 $1,158.96
Annual deductible Individual $0 $0 $150 Network:
$193
Out-of-Network:
$386
Family $0 $0 $300 Network:
$386
Out-of-Network:
$772

Table 4: CY 2025 TRICARE Prime and TRICARE Select out-of-pocket costs: retirees, their family members, and all others

TRICARE Prime** TRICARE Select
Group A Group B Group A Group B
Annual catastrophic cap $3,000 $4,509 $4,261 $4,509
Preventive care visit $0 $0 $0 $0
Primary care $25 $25 Network:
$37
Out-of-Network:
25%* 		Network:
$32
Out-of-Network:
25%*
Specialty care $38 $38 Network:
$51
Out-of-Network:
25%* 		Network:
$51
Out-of-Network:
25%*
Emergency room visit $77 $77 Network:
$140
Out-of-Network:
25%* 		Network:
$103
Out-of-Network:
25%*
Urgent care center visit $38 $38 Network:
$37
Out-of-Network:
25%* 		Network:
$51
Out-of-Network:
25%*
Ambulatory surgery $77 $77 Network:
20%*
Out-of-Network:
25%* 		Network:
$122
Out-of-Network:
25%*
Ambulance, outpatient ground $51 $51 Network:
$115
Out-of-Network:
25%* 		Network:
$77
Out-of-Network:
25%*
Ambulance, outpatient air $20 $20 Network and
Out-of-Network:
25%* 		Network and
Out-of-Network:
25%*
Durable medical equipment 20% 20% Network:
20%*
Out-of-Network:
25%* 		Network:
20%*
Out-of-Network:
25%*
Inpatient admission Network $193 per admission $193 per admission $250/day up to 25% of hospital charges, plus 20% of separately billed services $225 per admission
Out-of-Network $193 per admission $193 per admission ǂ $1,221/day up to 25% of hosp. charges, plus 25% of separately billed services 25%*
Inpatient skilled nursing facility/rehab facility $38 per day $38 per day Network:
$250/day up to 25% of hospital charges, plus 20% of separately billed services
Out-of-Network: 25%* 		Network: $64 per day Out-of-Network: $386 per day or 20%* (whichever is less)

*Percentage of TRICARE maximum-allowable charge after annual deductible is met.
**Getting care out of network may result in point-of-service charges.
ǂ All final claims reimbursed under the TRICARE Diagnosis Related Group-based payment system are to be priced using the rules, weights, and rates in effect as of the date of discharge.

Note: The CY 2025 catastrophic cap for TRICARE Select Group A retirees who are survivors of active duty deceased sponsors or medically retired uniformed service members and their dependents is $3,000.

Premium-based plans

When you or your family members purchase a premium-based health plan, you pay a monthly or quarterly premium.

Table 5 shows the monthly premiums for TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult Prime, and TRICARE Young Adult Select. Table 6 shows quarterly premiums for the Continued Health Care Benefit Program. Changes from 2024 costs are in bold.

Table 5: CY 2025 TRICARE premium-based health plans monthly premiums

Premium-based health plan Member Only Member and Family
TRICARE Reserve Select $53.80 $274.48
TRICARE Retired Reserve $631.26 $1,513.04
TRICARE Young Adult- Prime Option $727.00 Not applicable
TRICARE Young Adult-Select Option $337.00 Not applicable

Table 6: CY 2025 TRICARE premium-based health plans quarterly premiums

Premium-based health plan Single Family
Continued Health Care Benefit Program $1,849.00 $4,621.00

It's important to know that your TRICARE Pharmacy Program costs and TRICARE Dental Program costs won't change on Jan. 1.

Want to review your costs for the current year? Go to 2024 costs. The 2025 TRICARE For Life costs will be posted early next year. Also, check out Cost Terms to learn about common healthcare terms and what they mean.

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